Liu S Y, Leighton T, Davis I, Klein S, Lippmann M, Bongard F
Department of Surgery, Harbor-UCLA Medical Center, UCLA School of Medicine.
J Laparoendosc Surg. 1991 Oct;1(5):241-6. doi: 10.1089/lps.1991.1.241.
This prospective study evaluates the extent and temporal course of the cardiorespiratory effects of CO2 during laparoscopic cholecystectomy in otherwise healthy patients. Sixteen patients (M:F = 3:13, average age = 40.2 +/- 14.1 years) were monitored with capnography, transesophageal cardiac output, continuous blood pressure, heart rate, and pulse oximetry. Arterial blood gases were obtained immediately before insufflation of the abdomen with CO2 and before desufflation. Average operative time was 137 +/- 13 minutes. Patients were paralyzed and mechanically ventilated. Minute ventilation was increased if EtCO2 exceeded 45 mmHg or rose by more than 12 mmHg from baseline. End tidal (EtCO2) and arterial CO2 (PaCO2) increased from 31.4 +/- 0.7 mmHg to 42.1 +/- 1.6 mmHg and 33.3 +/- 0.7 mmHg to 43.7 +/- 1.2 mmHg, respectively, during the course of the procedure. Arterial pH decreased from 7.43 +/- 0.01 to 7.34 +/- 0.01, while bicarbonate concentration remained unchanged. Thirteen of the 16 patients required increased minute ventilation due to hypercarbia detected by capnography. Blood pressure increased from 78 +/- 2 mmHg (mean) at the start to 98 +/- 2 mmHg. This increase was coincidental with the maximal PaCO2. Good agreement was observed between paired EtCO2 and PaCO2 measurements. Laparoscopic cholecystectomy with carbon dioxide insufflation causes significant respiratory acidosis and associated cardiovascular changes in otherwise healthy patients. Careful monitoring and cautious application of this technique in patients with pre-existing cardiopulmonary disorders will be required to prevent acute decompensation.
这项前瞻性研究评估了在健康患者的腹腔镜胆囊切除术中二氧化碳对心肺功能影响的程度和时间进程。16例患者（男:女 = 3:13，平均年龄 = 40.2±14.1岁）接受了二氧化碳图、经食管心输出量、连续血压、心率和脉搏血氧饱和度监测。在腹部用二氧化碳充气前和放气前立即采集动脉血气。平均手术时间为137±13分钟。患者接受麻痹并进行机械通气。如果呼气末二氧化碳（EtCO2）超过45 mmHg或比基线升高超过12 mmHg，则增加分钟通气量。在手术过程中，呼气末（EtCO2）和动脉二氧化碳（PaCO2）分别从31.4±0.7 mmHg升至42.1±1.6 mmHg和从33.3±0.7 mmHg升至43.7±1.2 mmHg。动脉pH值从7.43±0.01降至7.34±0.01，而碳酸氢盐浓度保持不变。16例患者中有13例因二氧化碳图检测到的高碳酸血症而需要增加分钟通气量。血压从开始时的平均78±2 mmHg升至98±2 mmHg。这种升高与最大PaCO2同时出现。配对的EtCO2和PaCO2测量结果之间观察到良好的一致性。在健康患者中，二氧化碳充气的腹腔镜胆囊切除术会导致明显的呼吸性酸中毒和相关的心血管变化。对于有既往心肺疾病的患者，需要仔细监测并谨慎应用该技术以防止急性失代偿。
